Patients not politics

On 2 November, yet more violence broke out in Myanmar’s Rakhine state. Two incidents between Muslim Rohingya and Kaman communities and Rakhine Buddhist communities resulted in two deaths and five people wounded, two with such severe injuries that they later died in hospital.

There is long-standing tension between ethnic Rakhine people, who make up the majority of the state’s population, and Muslims, many of whom are Rohingya and regarded by the authorities as illegal immigrants.

After receiving a phonecall from the leaders of the camp for displaced people where the first incident took place, our medical teams transferred three injured Muslims to hospital. Later we heard about the second incident and were told that two injured Rakhine Buddhists had been transported to hospital in Sittwe by a boat organised by their community. No one contacted MSF for support with this hospital referral. Had they done so, we would have been ready to provide immediate support, as we have done frequently in the past.

Since the incidents, MSF has been accused – in media reports and through social media – of bias in favour of Muslim patients. Such accusations undermine the very act of providing lifesaving healthcare in Rakhine state, where we are working on the request of the government of Myanmar to provide healthcare to communities that its own Ministry of Health finds difficult to reach. These challenges are largely a result of the hostility directed towards its staff, who have been threatened for trying to provide services to Muslim patients.

The result of the intimidation and hostility is that many people are cut off from healthcare. We provide services to these people, who are currently limited to their camps or villages due to movement restrictions. We also support communities living nearby, who may have freedom of movement but suffer due to tension and fear. We transport patients to hospital in the absence of a government-provided ambulance – a service open to anybody who needs it, regardless of their ethnicity, religion or any other factor.

Following the violence on 2 November, some within the Myanmar government have said that humanitarian assistance in Rakhine should be distributed on an equal basis, because needs are the same across all communities. Such statements demonstrate a profound lack of understanding of the principles by which humanitarian organisations like MSF operate – most notably that of impartiality, which requires that humanitarian assistance be provided where it is needed most.

While it is true that all communities in Rakhine have needs, those needs are very different. Muslim communities in Rakhine state have been cut off from fields, markets and government-provided services, with the exception of emergency health services at a single hospital. Many of them have been forced to leave their homes, and are restricted to squalid camps situated on salt flats and rice paddies.

This situation has generated significant humanitarian needs amongst Muslim communities, who suffer from inadequate provision of shelters and latrines, shortages of drinking water, and intermittent health services that result in avoidable deaths and an increased likelihood of epidemics.

Rakhine Buddhist communities have also have had their lives disrupted by violence, and the tension and fear that has followed, but have not been restricted in their movements and have a greater ability to access fields, markets and government services.

But Rakhine is one of the poorest states in Myanmar, and rural communities in particular remain extremely poor. All communities in the state need substantial development support to help them overcome decades of neglect and marginalisation at the hands of the former military regime.

The Myanmar government has requested support from international organisations in the form of both humanitarian and development assistance, including healthcare. With this request also comes a responsibility for authorities to explain to communities the role of these organisations, rather than to politicise the principles which guide our work.

If providing medical care can ever be referred to as ‘biased’, it is a bias towards patients. It is a bias that is based on medical needs, regardless of any other factor. That has always been our organisation’s key underlying principle, and is one of the reasons why we have been able to work in some of the most challenging places in the world, providing healthcare to people who really need it, for more than 40 years.

We call on the government and the communities of Rakhine to work together with international organisations to ensure that all patients in need of access to emergency medical services get the care that they need, regardless of their background.

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Lauren Cooney is Operational Manager for Myanmar for the international medical organisation Médecins Sans Frontières/Doctors Without Borders (MSF)

This article originally appeared in the Jakarta Post, Bangkok Post and Myanmar Times